Return to Military Duty after Multi-ligament Knee InjuriesJerry Enad, LCDR, MC, USN; Chad Zehms, LCDR, MC, USNR

Bone and Joint Institute, Naval Medical Center Portsmouth, VirginiaEST. 1830

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Return to Military Duty after Multi-ligament Knee Injuries

The views expressed in this article are those of the authors) and do not necessarily reflect the official policy or position of the

Department of the Navy, Department of Defense, or the United States Government. Research data derived from an approved

Naval Medical Center, Portsmouth, VA IRB/IACUC protocol (CIP #P03-064). I am a military service member. This work was

prepared as part of my official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any

work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as

part of that person’s official duties.

To present an administrative analysis of return-to-duty rates in military patients who required surgical repair or reconstruction of more than one ligament in an injured knee.

Objective:

Methods:

Results: Conclusion:

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Multi-ligament knee injuries can be treated successfully with reconstruction of the cruciate ligaments and appropriate collateral ligament surgery.

Return to full duty after multi-ligament surgery can be expected at a similar rate as isolated ACL reconstructions, but the period of limited duty may be longer.

Further clinical study is warranted to determine how functional the patients were after returning to duty.

A retrospective review of surgical records and medical boards data identified 29 active duty patients who underwent multi-ligament knee surgery over a 5-year period (2001 to 2005). Two ligaments were surgically treated in 24 subjects and three ligaments were surgically treated in 5 subjects (Table 1).

Table 1. Combined injury patterns in 29 subjects

ACL PCL MCL LCL/P C subtotal

+ + 19+ + 4+ + 1+ + + 3+ + + 2

L

! ACL injuries were reconstructed endoscopically, PCL injuries were reconstructed arthroscopically-assisted, and collateral ligaments were either repaired or reconstructed with an open technique.

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Measured endpoints were either eventual return-to-full-duty or medical-separation-discharge postoperatively.

A cohort of patients who underwent only isolated primary ACL reconstruction during the same treatment period was used for endpoint comparison.

Table 2. Medical board results of isolated ACL reconstructions vs

Multi-ligament injuries in a military population.

Total Return to Medical patients Duty Discharge

Board

ACL 206 190 16 (7.8%)only (92.2%)

Multi- 29 26 3 (10.3%)ligament (89.7%)

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There were 27 men and 2 women, with mean age of 29.9 + 6.5 years (range, 21 to 44 years).

Twenty-six patients (90%) return to full military duty at an average of 7.8 + 2.6 months postoperatively (range, 6 to 12 months).

Three patients were unable to return to full duty and were medically separated from military service at 10, 12, and 10 months respectively.

In comparison, 190 of 206 (92.2%) other patients who underwent isolated primary ACL reconstruction returned to full military duty at an average of 7.2 + 2.3 months (range, 6 to 15 months).